HIRSCHEL'S RULES AND EXAMPLES FOR THE STUDY OF PHARMACODYNAMICS.

Translated by THOMAS HAYLE, M. D., 8vo., pp. 213, Manchester, Turner

It was in the year 1841 that Dr. Hirschel, not yet convinced of the truth of Homoeopathy, wrote critical letters upon the system in Hacker's Medical Argos. Having after a time assured himself of the general correctness of the theories of Hahnemann, he betook himself to a careful study of the Materia Medica. The book before us is an expose of the method he employed to acquire a knowledge of the many facts embraced in this vast field. The work attracts our attention, as the sustained effort of a mature mind, in downright earnestness, to accomplish a certain desirable result, in the shortest and most perfect manner.

Dr. Hirschel, in the plan adopted, had the benefit of the experience and written directions of our own Hering, published in 1837, at Allentown, Penn., and at Leipzig, in his work entitled “Wirkungen Schlangengiftes.“The plan proposed by Dr. Hering, is somewhat different from that followed by Dr. Hirschel. We shall take pains to point out the differences between the two methods; and shall recommend a system founded upon both.

The plan proposed by Dr. Hering, and which, as being prior to that of Dr. Hirschel, we shall first consider, is somewhat as follows:-The student is to take, for instance, some one of the polychrests, and read its list of symptoms over attentively a number of times, with a special and particular object at each perusal. At the first reading, he is to pay especial regard to the organs which are the favorite bases for the manifestation of the pathogenetic effects of the drug. At the second reading, the character of the symptoms is to be particularly noticed, the first reading being but a preparation, so to speak, for this one. The third reading is made with particular attention to the conditions under which the symptoms take place, and at the fourth, we have to notice the combinations of the symptoms, observing what symptoms follow each other, or occur simultaneously. Going through all the organs, in this way, upon which the remedy seems to have a particular action, we shall, by and by, attain a pretty good knowledge or one drug, which we shall be very likely to retain. Now, then, comes in comparison with other drugs; upon which Dr. Hering depends for the element of association, with which he hopes to bind the memory to the whole phenomena. A second remedy is studied in the same manner, and for the sake of convenience, we select the one which seems nearest the first in its similar action.

The drug thus selected will of course have distinct correspondential relations to the same class of organs, as has the drug first studied, and is chosen for the second study on that account. The organ upon which the pathogenesis of the first drug is principally manifest, now has the symptoms of the second drug added to, and compared with, those already received; and so, in the ratio of their illustrative importance, have the rest of the organs. To demonstrate the plan, we may suppose a series of parallel columns, at the head of which stand the names of the different organs, the symptoms occurring in which, with the name of the drug which produces them, following down the list in the order of their importance.

By this plan, the Medical Disease, with the causative drug agent, which may affect an individual organ, is discovered; but, and here is the great trouble, the totality of the medical disease of any individual drug is lost sight of. As we proceed in our studies, the organ possesses a long list of remedies, having particular relations to it, and as a natural consequence, the individuality of the organ, so to speak, with its long train of symptoms, will assert itself superior in the memory to the individuality of the drug, i. e. we shall be more apt to remember what drugs affect a given organ, than what symptoms belong to a given drug.

Now a knowledge of pathogenesis, as connected with and classified by organs is by no means so serviceable in the treatment of disease, as is that obtained in other ways; for the reason that in this case, but small correspondential relation exists between the picture of the disease and that of the remedy. Disease does not show itself, in actual practice, as attached to any particular organ or set of organs; but as something evidently pervading the totality-the entire personality of the man.

There are two methods suggested by Dr. Hirschel, in the book under review, the Analytico-Synthetic, which he illustrates by a study of Bryonia, and the Synthetico-Analytic, which is illustrated by Rhus. By the first plan, a knowledge of the essential properties of the drug is obtained by a process similar to that of Dr. Hering, in so far as the individualization of organs is concerned, although there is no effort at comparison. Beginning with the Head and Scalp, the symptoms are arranged in three parallel columns, the first of which contains the character, the second the locality, and the third the condition of the morbid manifestations. Then follow “conclusions from the foregoing;” a general view is taken of the symptoms thus far evolved, and the bearing of the drug upon diseases affecting the head and scalp is set forth. We then pass to the face, the symptoms of which are divided, (analyzed,) in a similar manner, and clinical inferences drawn in conclusion. This plan is followed through all the organs, and at the end of 115 pages, we have the final result-in the ”General characteristics of Bryonia.”

The leading points in this general summing up are of sufficient importance to be cited here,

A. PHYSIOLOGICAL CHARACTER.

The essential part of all the actions of Bryonia is excitement of the vaso-motory actions.

(2.) This appears predominant in the course of the venous system, and in the sphere of the capillary system, and more especially in its venous portion.

(3.) This excitement of the vascular activity goes hand in hand in Bryonia with excitement of the nerves of sensation.

(4.) The increase of the circulatory movement appears as the first degree of the excitement of the vaso-motory activity; the hyperaemia and congestion of the vessels, especially the venous, as the second; the action on the blood itself in inflammation, or in other metamorphic changes, as the third.

II. From this fundamental property the character of the reaction of Bryonia is explainable.

(1.) It is adapted specially for intermediate states and transition formations partly as regards the participation of the nervous and vascular systems, partly as regards the transition from states of excitement to different forms of deposition. It is consequently suitable for erethistic states, in which a certain mobility of the blood (exalted irritability) with increased sensibility of the nervous system (exalted sensibility) is present; for such as are intermediate between synochal and venous states, or in the course of the disease for the period, at which a move pronounced synochal or erethistic character is passing into a nervous, connected with decomposition of blood.

(2.) Since we find these wavering states of excitability, also at the period of childhood, in the female sex in general, and quite specially during pregnancy and the puerperal state, in the melancholic and choleric temperament, in nervous bilious constitutions, states likewise closely connected with the venosity every where predominant, these individual physico-psychical states quite specially answer to Bryonia.

III. On these fundamental relations a special light is thrown by (a) the pains which Bryonia calls out, (b) the peculiar conditions under which aggravation occurs.

Proceeding in our extracts we come to Division B of the “Final Result,” where we find under the term ANTIOLOGY,

All circumstances which excite the circulation will produce phenomena similar to those of Bryonia, as vexation, anger, excessive exertions, &c., &c.

Farther on we have Division C, involving the LOCAL RELATIONS OF THE BRYONIA DISEASE.

Here we find Bryonia related to (1.) the venom and capillary system, and to the matt of the blood itself; (2.) to the peripheral, but also central nervous system (brain, spinal marrow, spinal nerves, nervous trigeminus ganglia): (3.) to the serous membranes (pleura, peritoneum, cerebral meninges); (4.) to the muscles and fibrous membranes, tendons, ligaments, neurilema, periosteum, especially the articular apparatus); (5.) to the mucous membranes, (mouth, stomach and intestinal canal, eyes, nose, ears, larynx, trachea, &c, & c); (6.) to the lymphatic system and glandular apparatus; (7.) to the biliary apparatus (liver, gall-bladder,); (8.) to the skin, and (9.) to the cellular membrane.

Division D. FORMS OR DISEASE. From the physiological fundamental relation, (A) together with the Aetiological (B) and Anatomical (C) character of Bryonia, result several pathological states which are most intimately connected together.

The names of the corresponding diseases are arranged in topographical order in Division E. Among them we find-Typhus, Neuralgia, Rheumatism, Catarrh, Bronchitis, Pneumonia, Hydrothorax, Pericarditis, Peritonitis, Hepatitis, Spinal Irritation, Purpura, Morbilli, and Intermittent, inflammatory, catarrhal, gastric, exanthematic, rheumatic and gouty fevers.

It will be observed that the foregoing conclusions have been arrived at from an analysis of the symptoms of the Materia Medica Pura. A general view o Bryonia is gained from the individualized symptoms, aggregated in the manner exhibited. The opposite plan, of proceeding from generals to particulars rather than from particulars to generals, is exemplified by a study of Rhus.

From a knowledge of the “general symptoms” of Rhus, an idea is formed of the general characteristics of the Rhus action; and this general idea is proved, (in the course of the study) by reference to individual symptoms bearing upon it.

Both the studies of Bryonia and Rhus are very valuable contributions to Homoeopathic literature. We sincerely hope that the polemic spirit at present abroad in Germany, between the two schools of Reformed Medicine, and which we see has somewhat affected our author, will not draw him from these, his more useful pursuits.

The practitioner, whose clinical experience enables him to understand the conclusions of Dr. Hirschel, as cited above, in connection with the studies of Bryonia and Rhus, will receive the greatest benefit, from the work before us. Students, however, who have no personal knowledge of “erethistic” states, “states of transition,” and states in which a “pronounced synochal is passing into a nervous, connected with decomposition of blood,” and who can hardly make out what is meant by such technicalities at “a certain mobility of the blood,” will not fully appreciate the praiseworthy endeavors of the author. The fact is, these “Rules” are most needed by the very people who are likely to use them least, viz: physicians in good practice, whose experience has made them familiar with the rations forms of disease, and who can see the relation between the evolved characteristics of the drug, and those of a given and well known morbid manifestation.

This learning the Materia Medica from recorded provings, with a written description of the disease for which the drug is to be prescribed, is as if a pupil of Kensett, in landscape painting, should spend his time in the study of painting materials and written descriptions of Conway or Newport, with never a sight of the canvas he is to employ in the practice of his art.

The law of Retention, under which the memory acts, is undoubtedly dependent upon association, and no one, who has treated a case with Bryonia, in which that remedy was indicated, will fail to remember both the reasons for its prescription, and the concomitant surroundings which influenced its use. We venture to say that a single use of Bryonia in any given case, when conjoined with the study attendant on the selection of the drug, will do more towards teaching the true qualities and therapeutic value of the drug, than ten essays, even if composed with the skill which is evident in the studies of Dr. Hirschel.

In view of this fact, the best plan, as it seems to us, for the acquirement of the Materia Medica, is as follows:-Let the student, be he a tyro, or an old-school practitioner seeking a knowledge of Homoeopathy, take a given case of acute disease-for chronic diseases belong to the higher mathematics of our art-and turning to Jahr's Repertory, notice the drugs in common use in that form of disease. Let him decide which of the drugs named is the proper one for the individual case, influenced in his choice by the directions found under the “specific indications”-Then administer the remedy-and forthwith commence the study of the drug administered, in connection with the disease and the drug symptoms evolved in the case, whether they be curative or pathogenetic. We are well satisfied this will impress on the memory the peculiar characteristics of the remedy more rapidly and more lastingly, than will any other plan. Of this our own experience assures us.

This course of clinical self-instruction, at the end of a few months, or perhaps a year, will certainly make a good practitioner. In the higher walks of pathogenetic knowledge, such studies as these of Dr. Hirschel, are excellent guides; but each one must make these studies for himself, in the quiet and retirement of his own study, and not undertake them, until having become a good practitioner.